Aging Tattoos

For older adults, tattoos were exclusively for sailors, convicts, bikers and indigenous groups. However, now, more than a third of 18-25 year olds in the USA have a tattoo adorning their body. Despite the recent tattoo boom there has been a dramatic decline in reports of infections that were associated with tattoos. But there are other concerns with tattoos, least of which is the aging of tattoos.

Aging skin changes shape, composition and elasticity and tattoos, because they are embedded in the skin, reflect these changes. Ian Eames at the University College London studied this change by developing a mathematical model of how tattoos ‘move’ with age.  There is physics, chemistry and biology.

Tattoos are ink suspended in a solution made up of ethyl alcohol, purified water, witch hazel, listerine, propylene glycol or glycerin (typically obtained from animal fats.) Tattoo inks can be made up of various particles. Although there are non-metallic colors (black which is made by burning animal bones down to charcoal), most colors can only be achieved using metals—heavy metals—including mercury, lead, cadmium, nickel, zinc, antimony, beryllium, chromium, cobalt, nickel, arsenic and iron.

In California after 1986--when Proposition 65 was passed--most tattoo parlors had to warn their patrons that tattoo inks contain heavy metals and are known to cause cancer, birth defects, and other reproductive harm. However some colors can only be achieved by using metallic ink. The metals are suspended in the skin by puncturing the top layer—some at 3000 punctures a minute—and leaving ink embedded within these punctures.

To protect itself the body's immune system reacts to this trauma by sending white blood cells to the area—causing visible redness. White blood cells attack the area and attach themselves to some of the heavy metals and clear them out of the body. The rest of the heavy metals are encased in protective cells and sealed within the skin.

With time, as these protective cells divide, or die, they exit the body taking with them the heavy metal that they have encased.  Laser treatment to remove tattoos speed up this process by killing these cells—and increasing the exposure to toxicity from newly released heavy metals. Like a fading colored cloth, the tattoo simply looses its detail both in terms of colors—some colors being more prone to fading than others—and definition. Intricate details in a tattoo are lost first. Also with older tattoos  the ink particles move deeper into the skin over time making the tattoo less distinct and harder to remove using laser treatment. Metallic tattoos also distort magnetic resonance imaging.

A study conducted in 2008 reported that up to 20% of the tattooed individuals regret their decision and many of them sought advice for tattoo removal. But the aging of tattoos is not related to physics, chemistry or biology, but is related to mindset. What you think is cool at 18-25 might not be so cool once you have grandkids. The aging of tattoos is related to leaving a permanent testament of a bygone era.

Mario Garrett, Ph.D., is a professor of gerontology at San Diego State University and can be reached at mariusgarrett@yahoo.com

Aging Movie Stars

Tonsillitis and aging

Crying among Older Adults

There is a hint of disgrace associated with crying, especially among older men.   The stigma is not surprising since most scientific studies attempt to associate crying with depression. In fact, among older adults, depression is often not related to feeling sad. What emerges is that  we know very little about crying. Not only is there no clear-cut association that crying is a sign of depression, there are also very few studies reporting the opposite—that crying has healing benefits, when crying is not a response to pain or anger. 

A popular view is that crying can have a positive psychological as well as a physical benefit, a  view shared in popular literature. In a review of 140 years of popular fiction, crying is promoted not only as beneficial, but most warned readers that keeping back tears would harm them. Even Hollywood knows this and makes money selling us tearjerkers.

Lauren Bylsma now with the University of Pittsburgh, and her colleagues reported that when 4000 men and women in more than 30 countries were asked about crying, most people—in retrospect—reported improved mood, reduced tension and feelings of relief after crying. But this report of benefits from crying is not repeated in a laboratory setting,. When adults are made to cry in response to a sad film, report feeling worse—increased sadness and distress—than those who did not cry. Of course it could be a matter of timing. Using another example, people are more likely to report being relaxed an hour after jogging than immediately after. And the same might be the case with crying. There might be a time lag in reporting positive effects from crying.

And what about gender differences? Women cry more often and more intensely than men, although both report equal benefits. Interestingly what researchers have found is that people who suffer from alexithymia—the lack of understanding of emotions—reported fewer episodes of crying and reported less positive mood benefits as a result of crying.

What is missing from these analyses is the fact that crying can be a social behavior. Many of us cry, some privately and infrequently, others more consistently and publicly.  In some cultures there are criers who are paid to cry at funerals. There is a social context as well as a psychological one. Crying is also a learned behavior. Men are taught not to cry from an early age, while women elicit support and compassion when they cry. Social crying might be a form of social behavior in order to elicit empathy from others. And the cues of crying are so strong that even dogs express empathy when strangers are crying.

Crying among older adults is complex. There is evidence of benefits but it depends on who you are. If you are a happy person you gain more from crying than if you are a sad person, if you empathize you are more likely to benefit. There is also a positive social component to crying that women might have been exposed to more than men.  The benefits of crying might reflect more who you are than what you are emotional about.

Mario Garrett, Ph.D., is a professor of gerontology at San Diego State University and can be reached at mariusgarrett@yahoo.com

We are all Becoming Demented

For the first time since 1984 there is a new clinical diagnostic criteria for Alzheimer's disease dementia.  Published in April 19, 2011 in Alzheimer's & Dementia: The National Institute on Aging working with the Alzheimer's Association have expanded what we now consider  dementia.

While the previous guidelines only recognized one stage—Alzheimer’s dementia—the new guidelines propose that Alzheimer’s disease progresses on a continuum with three stages—an early, preclinical stage with no symptoms; a middle stage of mild cognitive impairment (MCI); and a final stage of Alzheimer’s dementia.  

These new guidelines forge a solid causal link. What was before just a probability of association is now seen as a causal progression from changes in the  brain that have no symptoms, to mild problems with thinking and memory and ending with dementia.

What made this possible is the introduction of new tests that can measure the health of the brain while the person is still alive. In the past, the only way to get a definitive prognosis of dementia was through an autopsy. Nowadays, especially with functional magnetic resonance imagery, the use of biomarkers makes it possible to measure changes in the brain before any symptoms appear, hence the new guidelines.

This ushers in a new era of fatalism. Unintentionally, these new guidelines are stoking the fear of dementia.  A MetLife Foundation study in 2010 reported that people over 55 dread getting Alzheimer’s more than any other disease--other then cancer. These new guidelines raises our sensitivity to subtler decline in thinking and memory. However it is important to stress that this linear connection is not as clear-cut as neuroscientists would have us admit.

MCI indicate difficulty with memory and thinking that are not normal but still allow the individual to  function independently. Many--but not all--people with MCI progress to Alzheimer’s dementia. However there are some important causes of MCI other than dementia--which the guidelines do not address--including medications, stroke or depression.

There are other inconsistencies in the logic of this causal path. As far back as thirty years ago M Marcel Mesulam with Northwestern University, reported 6 patients with progressive word-finding and naming difficulties that worsened over the years, but who did not develop a more generalized dementia.  Even if the connection between MCI and dementia is established, Mike Martin and his colleagues from Zurich, reported the results from their meta-analysis and concluded that cognitive interventions do lead to modest performance gains with older adults.

Even if the brain starts has the neuropathology it does not dictate the behavior. In the famous "Nuns Study" David Snowdon first reported this very strange anomaly. He found that a third of the nuns who behaved and acted free from dementia, were found to have the disease of Alzheimer’s during autopsy. Numerous studies have also found this lack of correlation between the disease and the behavior. More recently, Archana Balasubramanian with colleagues at UCLA reported that for 58 individuals, 90 years and older--who did not have any signs of dementia during three years prior to their death--at autopsy had evidence of the disease of dementia. All these studies erode the direct linear link between the disease and the behavior. There seems to be other mediating factors that the NIA guidelines need to address.

Mario Garrett, Ph.D., is a professor of gerontology at San Diego State University and can be reached at mariusgarrett@yahoo.com

Smell and Dementia

The sense of smell is accomplished through our olfactory system, which is an old system in our biological development. It is also one of the most evocative.

Smell acts as a portal to our emotions. It transports us directly to another time, another place and the only other medium that does this so quickly is the auditory sense--through music. But unlike music-- which can be written down and transferred in what Karl Popper calls World 3--smell is ephemeral.

Smell is somewhat undefined. Good, bad, sweet, acrid, then we loose track of translating the subtle smells into language. Smell has its own language and it cannot comfortably be translated into words.

Smell has power, it is evocative and nuanced so that a particular smell can immediately transport us to our first kiss, or the fear of high school, or your first child being born. Visceral and strong emotions which are hidden in the recesses of your mind. Never lost but subdued until dementia starts to erase them.

The olfactory system has a direct path to the brain. With humans, this system starts with the nose and ends a short distance away at the base of our brain. Olfactory receptors, with very thin fibers,  run  from the roof of the nasal cavity through perforations in the skull ending in the olfactory bulbs, which are a pair of swellings underneath the frontal lobes. It is the only sense that has such a direct physical connection to the brain. It is is also the first to be affected with the onset of dementia or Alzheimer’s. When the brain is affected by dementia, the area that deteriorates first is the area that is responsible for smell.

There is currently a patent, by researchers from Columbia University lead by Davangere Devanand, for a test using scents that include cheese, clove, fruit punch, leather, lemon, lilac, lime, menthol, orange, pineapple, smoke and strawberry. Using this test, the clinicians can predict that an individual who cannot recognize three of the ten scents are five times more likely to develop Alzheimer’s. It has also been found to predict Parkinson’s disease as well as certain types of schizophrenia and brain tumors.

Many people who lose their sense of smell also complain that they lose their sense of taste. Smell enhances the information we get from the mouth; salty, sweet, sour, and bitter tastes. Loss of taste might explain why weight loss is also an indication of dementia. It is not the weight loss on its own, but rather the loss of smell, which brings about the loss of appetite and consequently to diminished appetite.

There are some sixty seven medical conditions identified as possibly causing loss of smell--dementia being one of them. Some of these causes are temporary, such as colds, and nasal allergies such as hay fever.  It may also occur due to some medications and localized nasal polyps and tumors. Such factors reduces the odds of making the patent smell test a very reliable indicator in predicting dementia. But for individuals, it is important to notice changes in how well we can smell. So if you are having trouble with smell, check with your physician first to make sure that this is not a temporary condition.

Mario Garrett, Ph.D., is a professor of gerontology at San Diego State University and can be reached at mariusgarrett@yahoo.com

Super Brains and Dementia

We have a lot of evidence showing that the older you get the more problems we start having with our brains. In healthy adults they tend to shrink, and then they become prone to diseases, not excluding our nemesis of Alzheimer’s disease. We always assumed that these changes are fixed.  But then how do we explain exceptional older adults.

Exceptional adults are examples of what is possible, and not what is statistically likely.

When Emily Rogalski from Northwestern University looked at two groups of Chicago-area older adults of 80 years and older with similar education--12 who had exceptional memory, and ten normal older adults--she was not ready for the findings.  Her study reported that the exceptional group not only had sharp memories--as sharp as people 20 to 30 years younger--but she also found that their brains appear younger.  When compared to 50 to 65 year olds, these exceptional older adults had a thicker outer layer of the brain important for memory, attention and other thinking abilities. While in another region deep in the brain, they had thicker anterior cingulate--which is responsible for attention. Not only was there no shrinkage, these exceptional older adults show youthful brains.

Henrikje van Andel-Schipper was the oldest woman in the world when she died at age 115 in 2005. After Gert Holstege, from Groningen University, undertook a post-mortem of her brain he found few signs of Alzheimer's or other diseases. It seems that these exceptional people have escaped the normal effects of aging.

Jessica Evert from Ohio State University and her colleagues support this view. When examining death from heart disease, nonskin cancer, and stroke, 87% of male and 83% of female centenarians that they studied delayed or escaped these diseases.

If we apply the concept of escapers to the brain, then we can say that exceptional older adults escape from damaging their brain.  As far-fetched as this might seem, researchers are now focusing on studying how we might be developing the brain in detrimental ways. Known as negative plasticity—by not exercising the brain, learning things the wrong way and responding to stress—could be  causing the brain to shrink and develop inefficiently. 

Although brain shrinkage is related to aging, we now know it is not fixed and invariable. If the brain shrinks because of trauma that we impose upon it, then we need to start taking better care of our brain. The brain likes to be challenged, to be happy, stress free, fed well and exercised--just like a precious teen.

Mario Garrett, Ph.D., is a professor of gerontology at San Diego State University and can be reached at mariusgarrett@yahoo.com